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Erythema annulare centrifugum (EAC) is the most common of the major figurate erythemas, which also include erythema marginatum, erythema migrans, and erythema gyratum repens, being classified as a reactive erythema.[1] It has been suggested that the epidermal spongiosis histologically represents a reaction to one of many antigens, of which could be infectious agents, drugs, Crohn’s disease, pregnancy, autoimmune endocrinopathies, and occasionally, neoplasms.[2] Lesions present first as firm pink papules that expand centrifugally and develop central clearing, then enlarge centrifugally again to form a large plaque. Asymmetrical plaques can appear polycyclic. The peak incidence for EAC is the fifth decade of life, however EAC can appear throughout all age groups, with no known gender predilection.[1] EAC typically resolves with treatment of the underlying condition, however topical or systemic corticosteroids, antibiotics, or antihistamines have been used to treat the condition itself.

Roflumilast 0.3% cream is a topical phosphodiesterase-4 (PDE-4) inhibitor.[3] It is currently Food and Drug Administration approved to be used as a treatment for plaque psoriasis, including intertriginous skin in patients six years of age and older.[3] We report a case of EAC refractory to conventional treatments, successfully treated with roflumilast, which, to our knowledge, has not been previously reported in literature.

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2023 Alvin Yarrows Research Day at Beaumont Hospital Farmington Hills, Farmington Hills, MI, May 4, 2023.

Refractory Erythema Annulare Centrifugum Treated with Roflumilast